机械通气患者气管切开时机选择

Timing of Tracheostomy for Patients Requiring Mechanical Ventilation

目的评估气管切开时机对机械通气患者的影响。方法回顾性分析河南科技大学第一附属医院ICU2006年4月～2009年6月121例机械通气患者，按气管切开时间分为早切组（≤7d）和晚切组（〉7d），比较两组患者机械通气时间、入住ICU时间、呼吸机相关性肺炎（VAP）发生率和死亡率。结果121例机械通气患者中，早切组54例，晚切组67例。两组机械通气时间分别为（6．2±4．6）d和（8．44±．4）d（P〈0．05），人住ICU时间分别为（12．1±5．1）d和（14．4±6．9）d（P〈0．05），VAP发生率分别为20．4％和38．8％（P〈0．05），差异均具有统计学意义，死亡率为24．1％和29．9％（P〉0．05），差异无统计学意义。结论早期气管切开可缩短患者机械通气和人住ICU时间，降低VAP发生率，但对患者死亡率无影响。

Objective To assess the impact of tracheostomy timing on the outcome of patients requiring mechanical ventilation（MV）. Methods From April 2006 to June 2009, 121 patients under MV who received tracheostomy were divided into two groups ： early tracheostomy group when tracheostomy was performed before or on day 7 and late tracheostomy group when it was performed thereafter. The writers compared the lengths of MV, length of stay in ICU, prevalence of ventilator associated pneumonia and mortality rates between the two groups. Results 121 patients underwent tracheostomy, 54 of whom had early tracheostomy and 67 had late tracheostomy. Early tracheostomy was associated with significant reduction of length of MV （6.2 ＋ 4.6 vs 8.4 ＋ 4.4 days, P 〈 0.05 ） , length of stay in ICU （ 12.1± 5.1 vs 14.4 ±6.9 days, P 〈 0.05 ） and prevalence of ventilator associated pneumonia （20.4% for early tracheostomy group and 38.8% for late tracheostomy group, P 〈 0.05 ）. There were no differences in mortality rates between the two groups （24. 1 vs 29.9% , P 〉 0.05 ）. Conclusion This study demons-trates that early tracheostomy （ ≤7 days） is associated with shorter duration of MV, shorter ICU length of stay and low VAP rate without affecting survival.